Today's video I want to cover one of the most important topics of EMS which is pulmonary edema and congestive heart failure. My aim with this video by the end of it you're going to have this down cold and you're going to know it the rest of your life inside of EMS. So acute pulmonary edema, congestive heart failure. What's the first to find make sure we're on the same page and we understand whether we know what we're talking. about.
So first is we're talking about pulmonary edema. This is fluid in the bases of the lungs. Fluid is filling up the alveoli at the bottom of the lungs, thus causing gas exchange, oxygen going in, carbon dioxide going out to not perform up to standard, causing the patient to then be hypoxic, have low SpO2 levels, chest pain, difficulty breathing, calling the ambulance. Now we're going to talk about why this all happens. Let's go back to defining.
Fluid in the lungs due to the heart failure to pump effectively. So we have heart failure, which causes the heart not to pump effectively. So blood should be moving forward easily.
Instead, we're backing up. I'm going to explain about that a little bit. Now what else? Myocardial infarction, valve failure, chronically weak ventricles. Let me explain here.
Those are some of the reasons why you might end up in heart failure. A valve could fail. Valves help the blood move forward and not get stuck back up in the atrius, right? Muscle. If we have heart muscle dying due to it, heart attack, a myocardial infarction, that's an issue, right?
And obviously someone could be diagnosed with CHF, congestive heart failure, and they can have a flare-up of their CHF, or you find that now the left ventricle is getting more weak, their heart failure is flaring up, and now they have fluid pulmonary edema in their lungs acutely or gradually over a few days. and they call 911. So here's what occurs with CHF. First off, we have two sides of the heart, the right side and left side. So let's talk about the left side first.
Remember, the left ventricle pumps blood out to the rest of the body, right? Now, what is above the left ventricle? Well, there's a valve that sits there.
That's our mitral valve. And what's above that? Well, our left atrium. And then what is it? What?
actually feeds the left atrium, the pulmonary vein. Right, right. So what does this mean for our pulmonary edema?
How does this occur? Well, the big key I want to stick in your brain is blood backs up. Watch this.
So let's say the left ventricle fails as a pump, okay? The goal of that left ventricle is to push blood up through to the aorta. to get blood out to the rest of the body into our arterial system, right? So if the left ventricle fails, weak, it's weak, here's what happens. Pressure starts to build up in the pulmonary veins.
You get all this blood that is going to the pulmonary veins being pushed to the left side of the heart and then it starts to slow up and then eventually the pressure gets so great in the pulmonary veins it's got nowhere else to go so it leaks over into... or alveoli. Okay, so here's what happens.
Blood backs up into the lungs. Three, poor gas exchange occurs at the alveoli level, and that's how when you put your scope on your patient's chest, you hear rails bilaterally, and then you go, this could be CHF. Okay, that's left side heart failure.
Now, if the right side is involved as well, so I'll give you a scenario. Let's say the right ventricle fails the pump, right? Well, let's back up.
Hang on a second. Right ventricle, let me go up the chain. Okay, we have the tricuspid valve. Okay, let me up the chain again. We have the right atria.
Okay, then what feeds the right atria? The venous system. Particularly what? The SVC and IVC. What's that mean?
the superior vena cava and the inferior vena cava. That's the SVC and IVC. So the right ventricle fails. the pump, blood backs up into the SVC and the IVC.
And so what is that going to present as? It's going to present as blood fluid backing up in the venous system, causing venous congestion. How does that show itself in the body with this right side heart failure?
JVD, jugular vein distension. What else? Down by the legs.
Pedial edema. Edema in the legs. So this is what we want to look for and this is how CHF actually occurs. So you're called out, lights and sirens, difficulty breathing, chest pain patient.
You arrive. You find a 65 year old male sitting in front of you in a tripod position. Could this be CHF?
It certainly could be. Let's check it out. So here are some of the hallmark science symptoms.
you should watch for and let's go through them. Now each sign symptom has a story and let me explain. Chest pain of course because you got to do with the heart and the lungs.
Shortness of breath, increased respiratory rate, decreased not written down, SpO2, rails or crackles, bilaterally. Okay that rubbing sound we hear that bilaterally. Right?
Now, I put some stars here for some interesting cases. Let me explain. Test questions love to talk about exertional pain or exertional chores of breath.
So you go to somebody, they got a history of CHF and, ah, I'm just not feeling right. Every time I try and exercise or every time I try and get up and do the chores or every time I get out of bed, I'm just so short of breath. Ah, this isn't, this is not me. Those are.
like red flags okay there's something wrong i also want to touch on these parts which i i didn't start this one but this is a good one too fatigue or weakness tire that's what we're kind of getting at they're not themselves but a history of chf red flag okay increasing edema in the legs look out for that jvd cannot run down here but that jvd and the increase okay of the pedal edema. The inability to move around and do their daily activities they usually do. They can't sleep.
They just can't sleep because they're so short of breath. Keep waking up and they call 911 in the middle of the night. Tripod position. Put it all together. These are the signs and symptoms of CHF.
Make sure if you see this patient, make sure to do an EKG to further investigate what might be going on. Remember, CHF isn't just CHF. This patient could be having a heart attack right now.
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